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Digital image analysis of liver collagen predicts clinical outcome of recurrent hepatitis C virus 1 year after liver transplantation.
- Source :
-
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2011 Feb; Vol. 17 (2), pp. 178-88. - Publication Year :
- 2011
-
Abstract
- Clinical outcomes of recurrent hepatitis C virus after liver transplantation are difficult to predict. We evaluated collagen proportionate area (CPA), a quantitative histological index, at 1 year with respect to the first episode of clinical decompensation. Patients with biopsies at 1 year after liver transplantation were evaluated by Ishak stage/grade, and biopsy samples stained with Sirius red for digital image analysis were evaluated for CPA. Cox regression was used to evaluate variables associated with first appearance of clinical decompensation. Receiver operating characteristic (ROC) curves were also used. A total of 135 patients with median follow-up of 76 months were evaluated. At 1 year, median CPA was 4.6% (0.2%-36%) and Ishak stage was 0-2 in 101 patients, 3-4 in 23 patients, and 5-6 in 11 patients. Decompensation occurred in 26 (19.3%) at a median of 61 months (15-138). Univariately, CPA, tacrolimus monotherapy, and Ishak stage/grade at 1 year were associated with decompensation; upon multivariate analysis, only CPA was associated with decompensation (P = 0.010; Exp(B) = 1.169; 95%CI, 1.037-1.317). Area under the ROC curve was 0.97 (95%CI, 0.94-0.99). A cutoff value of 6% of CPA had 82% sensitivity and 95% specificity for decompensation. In the 89 patients with hepatic venous pressure gradient (HVPG) measurement, similar results were obtained. When both cutoffs of CPA > 6% and HVPG ≥ 6 mm Hg were used, all patients decompensated. Thus, CPA at 1-year biopsy after liver transplantation was highly predictive of clinical outcome in patients infected with hepatitis C virus who underwent transplantation, better than Ishak stage or HVPG.<br /> (Copyright © 2011 American Association for the Study of Liver Diseases.)
- Subjects :
- Adolescent
Adult
Aged
Biopsy
Child
End Stage Liver Disease pathology
End Stage Liver Disease physiopathology
End Stage Liver Disease virology
Female
Hepatic Veins physiopathology
Hepatitis C complications
Hepatitis C metabolism
Hepatitis C pathology
Hepatitis C physiopathology
Humans
Kaplan-Meier Estimate
Liver blood supply
Liver pathology
Liver virology
Liver Cirrhosis metabolism
Liver Cirrhosis pathology
Liver Cirrhosis physiopathology
Liver Cirrhosis virology
London
Male
Middle Aged
Predictive Value of Tests
Proportional Hazards Models
ROC Curve
Recurrence
Retrospective Studies
Risk Assessment
Risk Factors
Sensitivity and Specificity
Time Factors
Venous Pressure
Young Adult
Collagen metabolism
End Stage Liver Disease surgery
Hepatitis C surgery
Image Interpretation, Computer-Assisted
Liver metabolism
Liver surgery
Liver Cirrhosis surgery
Liver Transplantation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1527-6473
- Volume :
- 17
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
- Publication Type :
- Academic Journal
- Accession number :
- 21280191
- Full Text :
- https://doi.org/10.1002/lt.22209